Concerned about the money some doctors take from pharmaceutical companies, the University of Minnesota Medical School is asking an internal group to take a closer look at those payments and their possible influence on treatment.

Led by two U doctors, the group plans to examine the relationships between university physicians and drug firms and whether money creates conflicts of interest.

The move comes a few months after a Journal of the American Medical Association report showed doctors across Minnesota, including some doctors at the medical school, collected more than $30 million from drug firms between 2002 and 2004 for research, travel, meals, consulting and lectures.

"As we recognize our medical school's strengths," the dean, Dr. Deborah Powell, wrote in a May memo, "we also need to examine an area in which we may have some vulnerabilities: our relationships with pharmaceutical companies."

Powell said she wasn't calling for an immediate ban on payments, but she acknowledged "there are problems when some physicians present educational efforts funded by companies that appear much like marketing."

What is the pharmaceutical industry getting for its money? That's the lingering question.

Powell's memo circulated a few days after the New York Times featured a wrenching story of a Minnesota girl's controversial treatment by a U psychiatrist who prescribed an anti-psychotic drug for an eating disorder. The psychiatrist had received more than $7,000 in speaking fees from 2003 to 2004 from the drug maker.

Minnesota and Vermont are the only states that require drug company payments to doctors to be public. But the Minnesota data sat largely unviewed until researchers with the consumer group Public Citizen combed through the paper records and reported their findings in the JAMA article.

Now, two dozen organizations, including the Mayo Clinic, HealthPartners and Park Nicollet, have obtained copies, and some are reviewing their own policies governing relationships between doctors and drug makers.

For some, the payments issue is more about objectivity.

"It's a patient-safety issue," said Josh Lackner, the U medical school student who worked with Public Citizen on the research.

Drug salesmen, he said, befriend doctors because "they're paid by for-profit companies to do this. Befriending doctors is a job, and it's a job because it actually works."

What changes would he like to see?

"A good starting point would be barring faculty from speaking on behalf of pharmaceutical products and to also think about limiting paid positions on pharmaceutical boards," said Lackner, who hopes to land a spot on the U task force.

Most doctors who take payments or attend corporate-sponsored events say the money doesn't affect the choices they make in treating patients or conducting studies. Some research, however, suggests drug company money influences doctors - whether they know it or not.

Many local health care organizations have policies prohibiting any practices that might adversely affect how doctors prescribe medicine.

Mayo Clinic has a panel that reviews any doctor's request to receive drug company funding for a speech or research. Doctors who receive a drug company's money for research can't also receive money from that company for speaking engagements or to serve on speakers' bureaus. When providing speakers, a drug firm sends doctors to clinics or meeting groups to speak about a product.

The pharmaceutical industry says delivering doctors essential information about medicines they prescribe benefits patients and health care. The industry's voluntary code of conduct says grants, consulting gigs, contracts or gifts to doctors may never be offered in exchange for an agreement to prescribe a product.

As the issue percolates at the U, it's also gaining a higher profile nationally. In late June, a U.S. Senate panel led by Wisconsin Democrat Herb Kohl held hearings on drug company payments and their influence on doctors.

"While there are voluntary guidelines already in place, it is clear they are not being followed. ... Many of these gifts are not illegal, but we need them disclosed," Kohl said in a prepared statement.

"I think this issue has legs right now," Lackner said. "I think it's an issue that people definitely care about."

Paul Tosto covers higher education and can be reached at ptosto@pioneerpress.com or 651-228-2119. Jeremy Olson covers health issues and can be reached at jolson@pioneerpress.com or 651-228-5583.

ONLINE

  • Go to   extra.twincities.com/CAR/doctors/ to find a searchable database of Minnesota doctors and the payments they received from pharmaceutical companies.

  • Go to   www.phrma.org/news_room/press_releases/phrma_statement_on_jama_article/ to read the industry's critical response to the Public Citizen research on drug company payments in Minnesota and Vermont.

    BIG SPENDERS

    Doctors and medical organizations in Minnesota received more than $42 million from the pharmaceutical industry from 2002 through 2005 to conduct clinical research, serve on advisory boards, provide medical education and offer consulting and expertise, according to Minnesota Board of Pharmacy records. The following nine companies each spent more than $1 million in that period. The tally is likely incomplete because some companies failed to report spending figures to the state every year.

    GlaxoSmithKline: $7.9 million

    Eli Lilly: $6.7 million

    Amgen: $4.2 million

    Merck: $3.7 million

    Alcon: $3.7 million

    Wyeth: $2.3 million

    Novartis: $1.6 million

    3M Pharmaceuticals: $1.4 million

    AstraZeneca: $1.3 million